2016 Group Health Cooperative Plans

GHC Logo_Apply for CoverageBrand NEW Access PPO Plans for 2016!

In 2016 Group Health Cooperative dramatically changed their plans and lowered prices by 8% (I still not quite sure if it’s legal for companies to lower prices, lol)! They are finally a good option to look into with the NEW Access PPO plans (that uses the very wide First Choice Health Network…same that Moda and Assurant used).

First of all the GHC Access PPO Plans are about 20% lower cost than Premera for a similar benefit.  Below is a highlight of the main features of plans, click on the links to see the full detailed plans.

NOTE: The GHC plans are extremely price competitive for 2016! One way they keep the price down is that they do NOT cover on the job injuries for self employed people (that do not have L&I on themselves). If you work a desk job like me, this isn’t that big of an issue, however if you are a Real Estate agent, work construction or a job with your hands do NOT buy this plan.

 The PPO vs HMO Plan Overview

There are two different type of Group Health Cooperative plans on the market. The PPO (very wide First Choice network) and HMO (Group Health ONLY facilities). The Access PPO plan is brand new and extremely exciting! This is the first year that GHC expanded into allowing people to use the First Choice network of doctors, or you can still see doctors at Group Health facilities…the choice is up to you! All Max Out of Pocket’s are for in the insurance network only.

The Flex/Core HMO plans ONLY allow you to see doctors at Group Health Cooperative facilities. However with any plan if you ever have a life threatening or major emergency health issue go to any hospital and you will be covered as if you were in the network. They can do balance billing at times, but you are covered!

All plans cover Chiropractic visits (10 max), Acupuncture visits (12 max), and Physical Therapy/Massage (25 visits) are covered after the deductible.

Quick Overview of Plans

Another way that GHC keeps the prices low is that they have only 5 visits covered up front before the deductible for Gold, 4 for Silver and 3 for Bronze. While Premera does not have a limit on regular or specialist visits their plans are about 20% more expensive. Often times the savings more than makes up for this “doughnut hole” limitation on the GHC plans for number of up front visits. Once you satisfy your deductible then the visits are covered again and you only pay the regular copay for the doctor visit, yet wanted to be very up front about this change.

Access PPO Gold $1000 (plan details here): This plan allows you to have 5 total doctor visits up front before the deductible. Then you have to pay the $1,000 deductible/20% co-insurance/$4,500 Max Out of Pocket. For additional doctor visits it goes back to the $20 or $40 per visit after you pay the $1,000 deductible (doughnut hole). Overall the core plan design is the same as Premera, so if you are expecting to have major medical issues, then this is your plan (since it will save you about 20% compared with Premera). The Prescription Drug coverage is $5 for Generics and $30 for Brand Name (this discounted price is through the GHC online pharmacy). Overall very solid plan for the price and large nationwide coverage network.

Access PPO Silver $3,000 (plan details here): This plan allows you to have 4 total doctor visits up front before the deductible. Then you have to pay the $1,750 deductible/30% co-insurance/$6,850 Max Out of Pocket. For additional doctor visits it goes back to the $30 or $55 per visit after you pay the $1,750 deductible (doughnut hole). Overall this plan has a lower deductible than Premera (at $1,750 instead of Premera’s $3,000), but it covers Brand Name prescriptions AFTER the deductible (do not choose this plan if you take more expensive Rx).This is a very solid plan for the price and large nationwide coverage network.

Access PPO Bronze $6,000 (plan details here): This plan allows you to have only 3 Primary Care visits up front before the deductible. If you need to see a specialist it’s covered AFTER the deductible of $6,000 Deductible/30%/$6,850 Max Out of Pocket. For additional doctor visits it goes back to the $30 or $55 per visit after you pay the $6,000 deductible (doughnut hole). Overall the core plan design is similar to Premera, so pick this plan if you are healthy and expecting less medical expenses. The Prescription Drug coverage is $25 for Generics yet Brand Name Rx is covered AFTER the deductible (this discounted price is through the GHC online pharmacy). Do NOT buy this plan if you need Brand Name Rx (the Premera Silver has significantly better coverage for you). Overall very solid plan for the price and large nationwide coverage network.

Access PPO Silver $2,700 HSA (plan details here): Health Savings Accounts are a very unique type of coverage that ONLY cover medical expenses AFTER the $2,700 deductible (annual preventative exam is still no cost). The advantage is that they have a lower max out of pocket of $5,000 which is similar to a Gold plan, yet is cheaper cost since it’s a Silver plan. This is a great plan for those that intend on having a significant amount of medical expenses for the year (since the max out of pocket is $5,000) and you get a tax deduction for putting money in to a HSA checking account (See my HSA Blog here).

Access PPO Bronze $4,500 HSA (plan details here): This is a very similar plan to the Silver HSA, yet only makes sense if you want the cheapest plan with the strongest network. It operates in the same HSA manner with no up front doctor or Rx.

HSA 2016 limitsSince the HSA plan is a high deductible health plan, this enables you to set up a checking account where you can deposit up to a max of $3,350 single or $6,750 family amount. This is tax deductible and the money can be used tax free for qualifying medical expenses (for anyone in the immediate family, even if they are not on the HSA plan). This is truly one of the only ways you can use money without the government taxing it.

Below are my areas of expertise:

Gary Franke, MBA
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
gary@achieve-alpha.com
www.achieve-alpha.com

Achieve Alpha